Compliance Inspection Compliance Inspection Compliance Inspection # CI-2023-3744, Submission # Submission-2023-3974, UID # 49885
Status: System Replaced
 

System Status

System status on date: 11/02/2023 System Status: Noncompliant

System - Noncompliant

Reason(s) for noncompliance:
Tank Integrity (Compliance Component #2) - Failing to protect groundwater
Soil Separation (Compliance Component #4) - Failing to protect groundwater

Property Information

Property Information:
Compliance StatusProperty RecordProperty AddressProperty OwnerProperty Attributes
Compliance ExpirationCompliance StatusParent GeoCodePINSite AddressBuilding NumberStreet NameTypeDirCityMunicipalityzipOwnerLotBlockPlat Year BuiltProperty Hold
1503120330001TOWN OF MAYAMHERST H WILDER FOUNDATIONNo
Owner's representative:
Name:
Wilder Foundation
Phone:
(000000 - 0000
Email:
no@noemail.com

Impact on Public Health

System discharges sewage to
the ground surface:
No System discharges sewage to
drain tile or surface waters:
No System causes sewage backup
into dwelling or establishment:
No
Verification method(s):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
See Report

Tank Integrity

System consists of seepage pit,
cesspool, drywell, or leaching pit:
Yes
Sewage tank(s) leak below their
designed operating depth:
Yes
Verification method(s):
Other methods not listed (See Comments/Explanation)
Comments/Explanation:
See Report

Other Compliance Conditions

Maintenance hole covers are damaged, cracked,
unsecured, or appear to be structurally unsound:
No
Other issues (electrical hazards, etc.) to
immediately and adversely impact public
health or safety:
No
Explain:
See Report
System is non protective of groundwater for other
conditions as determined by the inspector:
No
Explain:
See Report

Date of Install

Date of install known: No

Soil Separation

Shoreland/Wellhead Protection/Food, beverage, lodging? Yes
Drainfield has at least a three-foot vertical separation
distance from periodically saturated soil or bedrock.:
No
Drainfield meets the designed vertical separation
distance from periodically saturated soil or bedrock.:
No
Verification method(s):
Conducted soil observation(s) (Attach boring logs)
Other (See Comments/Explanation)
Comments/Explanation:
See Report
A. Bottom of distribution media: 0 Decimal Feet
B. Periodically saturated soil/bedrock: 0 Decimal Feet
C. System separation: 0 Decimal Feet
D. Required compliance separation: 0 Decimal Feet

Operating Permit and Nitrogen BMP

Is system operating under an Operating Permit: No
Is the system required to employ Nitrogen BMP: No

Comments and File Attachments

Comments or recommendations:
See Report
Attach Files:

Certification

Inspector:
NameLicense NumberPhone NumberAddressMaintainerInstallerService ProviderDesignerInspector
Midwest Sewer ServicesL2896651-492-75506616 Indian Wells Trail Grant, MN 55110YesYesYesYesYes
Please search for and choose SELF/OTHER if what you need does not appear in the list
Inspector Email Address: brian@midwestsoiltesting.com

Terms

Certification
  • By submitting this form I hereby certify that all the necessary information has been gathered to determine the compliance status of this system. No determination of the future
    system performance has been nor can be made due to unknown conditions during system construction, possible abuse of the system, inadequate
    maintenance, or future water usage

Invoice #9736 (11/09/2023)

Charge Cost Quantity Total
Non-Taxable
added 11/09/2023 10:47 AM

$47 Flat Fee

$45.00 x 1 $45.00
Grand Total
Total $45.00
Payment 11/10/2023$45.00
Due$0.00
Action: Print  

Approvals

ApprovalSignatureOptions
ApplicantBrian Humpal - 11/09/2023 10:47 AM
28d6e71140737c67ab2951aa6166e294
927a907058227d2260d04f49eb6c0f48
 
#1 Compliance Inspection AcceptedSarah Borrell - 12/22/2023 9:04 AM
8b1426b3cced14aaf74b1bd6ac3bd49a
106ae5e9f0b04492e8318a27b67c1013
 
Inspection has been approved. All signatures have been obtained.
Text:
Privy #11 - abandoned
Letter to be mailed 1/2/24
File(s):
Text:
File(s):
    Compliance Letter Type: Failed System, Notice and Order to Comply, Separation Who's signature should be on the letter? Sarah Borrell Permit number to reference in "No Replace" letter:
    Was the letter sent? No Compliant/Non-Compliant: Noncompliant
    Certificate of Compliance:
      Letter of Non-Compliance:
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